The ENGAGEMENT TRIAD: Technology Enhanced Memory Care

Technology & Communication Help Engage Staff and Families in the Lives of Residents with Dementia

By Sarv Devaraj, PhD

AT A GLANCE

With Alzheimer’s disease and other forms of dementia on the rise as a result of an aging populace, memory care and assisted living facilities are seeking new methods for helping residents with these conditions. Advances in neurophysiology, enhanced brain imaging techniques, a focus on outcomes and increased funding have led to new ideas and approaches for providing the highest quality care and improving the quality of life for those struggling with memory disorders.

Staff and family engagement is of primary importance in various interventions designed for residents. Many of these activities are based on reminiscence therapy — recalling and re-experiencing significant events in the resident’s life. A review of research on theories and method in this area identifies four common elements: socialization, trigger events, activity balance and reminiscence — or STAR. The STAR framework presents a
holistic approach to looking at the core elements of a senior living community’s overall memory care program as well as examining the care plan for a particular resident. By identifying these four core areas, communities can measure the existence of these elements and their impact on residents’ quality of life and outcomes.

This process is empowered and facilitated by a Software-as-a-Service solution called SMILE™, a cloud-based, HIPAA compliant application through which staff can send and receive communication from families about life stories, the resident’s activities and future events. The software provides analytics and reporting by resident and activity so staff can track levels of engagement, document actions and generate analytics to evaluate the impact of interventions. Technology-based solutions offer a cost-effective means of fostering engagement among staff, families and even those afflicted with dementia to improve quality of life and affect the pace of disease progression.

SETTING THE STAGE: MEMORY CARE AND SENIOR LIVING

Providing memory care will fundamentally define senior living industry for the foreseeable future. A “date with demographic destiny” has arrived, and the statistics are stark: Data from Medicare in 2008 showed that 64 percent of beneficiaries residing in a nursing home had Alzheimer’s disease and other dementias. A 2010 report by AARP Public Policy Institute found that 42 percent of residents in assisted living facilities had Alzheimer’s disease and other dementias. The Alzheimer’s Association reports that 68 percent of patients or residents in nursing homes have some degree of cognitive impairment; of these, 27 percent have mild cognitive impairment and 41 percent have moderate to severe cognitive impairment.

Much improvement has been made in memory care; the movement toward person-centered care has changed the culture and approach of many organizations, shaped by shared concerns among consumers, policy makers and providers regarding the value and quality of care offered in traditional nursing homes. They have shown promise in improving quality of life as well as quality of care, while alleviating such problems as high staff turnover. And yet there is a growing consensus that memory care can and should be improved in all residential care settings especially given the widespread nature of cognitive impairment.

Organizations such as the Joint Commission are raising the bar. Effective July 1, 2014, The Joint Commission implemented new memory care requirements designed to “help accredited nursing care centers enable patients and residents with dementia to remain engaged in their environment at the level of their cognitive ability and to function at the highest level possible for as long as possible.” The emphasis is on resident centric activities tailored to the individual resident, including a balance of activities that incorporate family members.

Increasingly, state regulators and legislators are raising issues of quality of care in longterm, senior living and assisted living communities. Regulations examining the variety and quality of activities are expected. Lastly, savvy consumers (whether residents or their families) will demand better memory care as well.

ENGAGEMENT AND THE TRIAD: FAMILY, CAREGIVER, RESIDENT

As communities have incorporated the principles of person-centered care into their practices and programs, many have focused on “engagement.” In a Holleran Insight Poll released in February 2015, the overwhelming majority of respondents indicated that “engagement” is an integral
part of their community’s vernacular.

In some ways engagement might be viewed as the idea du jour. On the other hand, it could represent a breakthrough in the way memory care is organized and provided. But what does engagement mean, in the context of a senior living community and in the context of providing care for residents, most of whom will end up on the dementia spectrum?

Assisted Living and most Independent Living communities are facing several related problems:

  • The average age of new residents is 85
  • Most residents are somewhere on the dementia spectrum.
  • Quality memory/dementia care is more staff intensive and expensive.
  • Deteriorating memory/disease progression often precipitate resident move-outs

In facing these challenges communities can look to engagement as a strategy for success. In senior living, engagement can be viewed as a triad: family, caregiver, resident (see graphic below). Placing Family-Caregiver interactions at the bottom of the triangle is to emphasis their role in forming a strong base. This is particularly true when it comes to memory care — we will return to this point later. Involving and engaging families represent a powerful strategy for high quality care for individual residents and a successful operational and business strategy as well.

The Engagement Triad

Engaged family members also improve the quality of life of residents, which is a real, measurable and good thing. Even if it isn’t always helpful in slowing disease progression, it is an important and welcome adjunct to providing good care.

Recognition of the importance of engagement has lead senior housing to
design various interventions/activities designed for memory care residents. Many of these are based upon using reminiscence therapy — recalling and re-experiencing one’s life events to capture the resident’s life story. This has been shown to improve cognitive function and an improvement in quality of life, with a focus on improved emotions and overall happiness. National Institute of Health.

While residents, to the degree that they are able, can provide their own life history, family members and friends can provide
depth and additional insights. The act of getting the family members engaged in sharing their loved ones’ life stories can lead to better engagement of the family members with both the caregiving team and their family member/resident.

Once a resident’s biography is captured, it can form the basis of engagement with staff, which can develop personalized, life enriching activities. Using trigger events — key memories from the resident’s life brought back through pictures, music, videos and conversations — can have a positive effect on a resident’s quality of life.

Many contemporary approaches to memory care have been researched and developed in the person-centered care movement, with a special emphasis on Alzheimer’s disease.

Advances in neurophysiology, enhanced brain imaging techniques, a focus on outcomes and increased funding have led to new ideas and approaches for providing the highest quality care and improving the quality of life for those struggling with memory challenges. The box at right highlights some of the most recognized. All of these programs offer valuable insights and are being put to use in a variety of settings. The approaches have led to advancements in the care of residents.


STAR: A FRAMEWORK FOR MEMORY CARE

In reviewing the research, we have found four core elements that are part of these different theories and method. The four elements are socialization, trigger events, activity balance and reminiscence, or STAR. The STAR framework presents a holistic approach to looking at the core elements of a community’s overall memory care program as well as examining the care plan for a particular resident. By identifying these four core areas, communities can measure the existence of these elements and their impact on residents’ quality of life and outcomes.

Family-staff engagement can be viewed as powering the STAR framework, because the insights communicated between the family and caregiving team optimize the resident’s interactions and engagement. Importantly, the insights also aid in the development of personalized care plans that include a balance of activities shown to improve, or slow the decline in, cognitive and physical abilities.

TECHNOLOGY TO EMPOWER THE HUMAN TOUCH

The benefits of having an approach are clear. The ongoing challenges to operationalize family-staff engagement are many. They include issues around staff documentation of information, easy access to the material and reporting and analytics to evaluate impact.

The foremost challenge is people. Turnover requires ongoing training, and creating a new culture doesn’t happen overnight. Any plan to create an improved memory care program needs to address these elements. Technology can help.

Next on the list is documentation. Pen and paper are still the typical method of obtaining information about new residents. There are several limitations to this collection method. Access is limited to a few and much of the information is not relevant to day-to-day caregiver/resident interactions. Also missing are richly detailed stories about the resident’s past life. Family members or friends have no way to add to the paper document.

Last, but equally important, how can managers know that the care plan is being implemented successfully and how do they use this information? Reports on activities attended and individual encounters with residents around reminiscence, socializing and using trigger events must be created from paper logs and memories. This takes time and the data will be less accurate than if the information was collected in real time.

But what if technology could offer a solution?

Based upon these observations the CarexTech team has developed an effective Software-as-a-Service technology that addresses these points in a unique way, is HIPAA compliant and integrates with enterprise solutions. Its name is SMILE™. SMILE™got its name because every senior care professional who participated in product development focus groups broke into a smile when presented with a view into the family portal. They said this product would bring smiles to families and staff by focusing on the positives that are part of daily life but very often are not known outside of the individuals who were part of the interaction.

Smile’s integrated communication and engagement platform provides assisted living communities with a cloud-based solution through which they can send and receive communication from families in the form of text messages and emails from any computer or mobile device. Staff can share text, photos, video and audio files about special events using fully secure data encryption. The software provides analytics and reporting by resident and activity so staff can track levels of engagement.

SMILE™ facilitates the planning of activities tailored to residents’ individualized needs and assists in creating groups of residents based on shared interests. Families can use the portal to enter information about residents’ life stories and prior interests to help caregivers learn more about them as individuals. Elements such as Message Center, Activity Manager and Calendar Manager give staff tools to schedule and ensure residents participate in a balanced activity program personalized to their needs.

SMILE™ enables the family-staff engagement needed to needed to power the STAR framework or for any meaningful attempt to improve staff engagement with residents. Families and friends can add richer, more detailed stories about the past along with old photographs. The portal helps them remain connected to their loved one’s life in their new home by including recent activity participation and those scheduled in the future, messaging with staff and access to newsletters and menus.

SMILE™gives staff the information they need to be more effective using proven memory care techniques. Increasing engagement between families and staff results in richer stories. Technology makes it accessible when needed.

SUMMARY

Senior housing communities will continue to address memory care. The best
evidence points to more person-centered care. The best person-centered care
draws upon the input from an engaged family and then operationalizes that
knowledge in a way that allows for personalized and individualized care.

Technology, such as the SMILE™ program developed by CarexTech, can play a central role in enabling communities to provide an even better and more consistent level of care by helping to foster and utilize an engaged family with benefits for the resident, family, caregiving team as well as the operational results for the community.

Sarv Devaraj, PhD, is Fred V. Duda Chair Professor of Management at the University of Notre Dame, and Founder of CarexTech, Inc., South Bend, Ind.

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